Background information about dementia and home care services
In 1978, the National Health System was set up in Italy. In the same year, Local Health Authorities (USL) were created which were controlled by the municipalities. However, it was not until 2000 that a legal framework and financial basis for a national development of social services was established. Meanwhile, care for the elderly was entrusted to general practitioners, community care services organised by municipalities and associations. According to Nesti et al. (2003), “at least until the 1990s, Italy had no clear concept of the problems inherent to elderly people with care needs, nor was it clear which services were required to maintain their health.”
There is still a strong emphasis on support from the family. Care of the elderly is traditionally considered as a kind of “social duty” by the family, especially the women on whom the main burden of care falls. According to Auser (2001), “it is generally accepted as normal and legitimate that the community and institutions should become involved in caring for elderly family members only after the family resources – often interpreted in a very extended sense (up to the third degree of kinship) have run out (in Polverini et al. 2004).
Demand for home care services has nevertheless increased significantly but supply has been fairly limited. The percentage of over 65 year-olds using home care services in Italy is very low (i.e. 1% of the population) compared to other countries e.g. 5.5% in the United Kingdom, 6.5% in Germany and almost 10% in Scandinavia (Minguzzi in Polverini et al. 2004). Moreover, there have been considerable differences in the development and distribution of home care services, particularly between the north and south of the country. There are also differences between the populations. For example in the north, elderly people tend to live in better conditions; on the islands, such as Sicily and Sardinia, there is a higher percentage of chronic diseases and disability (Nesti et al. 2003). Services
There is still a strong emphasis on support from the family. Care of the elderly is traditionally considered as a kind of “social duty” by the family, especially the women on whom the main burden of care falls. According to Auser (2001), “it is generally accepted as normal and legitimate that the community and institutions should become involved in caring for elderly family members only after the family resources – often interpreted in a very extended sense (up to the third degree of kinship) have run out (in Polverini et al. 2004).
Demand for home care services has nevertheless increased significantly but supply has been fairly limited. The percentage of over 65 year-olds using home care services in Italy is very low (i.e. 1% of the population) compared to other countries e.g. 5.5% in the United Kingdom, 6.5% in Germany and almost 10% in Scandinavia (Minguzzi in Polverini et al. 2004). Moreover, there have been considerable differences in the development and distribution of home care services, particularly between the north and south of the country. There are also differences between the populations. For example in the north, elderly people tend to live in better conditions; on the islands, such as Sicily and Sardinia, there is a higher percentage of chronic diseases and disability (Nesti et al. 2003). Services